title: General practitioners' use of different cardiovascular risk assessment strategies: a qualitative study.
abstract: OBJECTIVE
  To identify factors that influence the extent to which general practitioners use absolute risk (AR) assessment in cardiovascular disease (CVD) risk assessment.
  
  
  METHODS
  Semi-structured interviews with 25 currently practising GPs from eight Divisions of General Practice in New South Wales, Australia, between October 2011 and May 2012. Data were analysed using framework analysis.
  
  
  RESULTS
  The study identified five strategies that GPs use with patients in different situations, defined in terms of the extent to which AR was used and the reasons given for this: the AR-focused strategy, used when AR assessment was considered useful for the patient; the AR-adjusted strategy, used to account for additional risk factors such as family history; the clinical judgement strategy, used when GPs considered that their judgement took multiple risk factors into account as effectively as AR; the passive disregard strategy, used when GPs lacked sufficient time, access or experience to use AR; and the active disregard strategy, used when AR was considered to be inappropriate for the patient. The strategies were linked with different opportunity, capability and motivation barriers to the use of AR.
  
  
  CONCLUSIONS
  This study provides an in-depth insight into the factors that influence GPs' use of AR in CVD risk assessment. The results suggest that GPs use a range of strategies in different situations, so different approaches may be required to improve the use of AR guidelines in practice.
authors.affiliation: Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. kirsten.mccaffery@sydney.edu.au.
authors.forename: Carissa
authors.initials: C
authors.lastname: Bonner
authors.forename: Jesse
authors.initials: J
authors.lastname: Jansen
authors.forename: Shannon
authors.initials: S
authors.lastname: McKinn
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors